The Government should consider giving GPs incentives to do NHS Health Checks via QOF, the public spending watchdog has said.
A report looking at cardiovascular disease prevention in England, published this week by the National Audit Office (NAO), concluded that ‘not enough people are offered or receive’ NHS Health Checks and the current system ‘isn’t working effectively’.
It highlighted that local authorities – who have had responsibility for commissioning the checks since 2013 – are not able to ‘require’ GP practices to provide health checks and are also ‘unable to routinely access practice data’ to monitor performance.
The report also recognised ‘concern’ among GPs about their ‘capacity’ to conduct health checks, and stated that the amount local authorities spent on individual checks fell in real terms from £56 to £43 between 2014 and 2023.
The NAO therefore urged the Department of Health and Social Care (DHSC) to review the ‘value’ of commissioning NHS Health Checks via local authorities compared to ‘alternative’ routes such as NHS England.
This ‘could include incentives for delivering health checks in the Quality and Outcomes Framework for primary care practitioners’, the report recommended (see also box below).
It also made recommendations aimed at increasing uptake among populations at ‘highest risk’ of CVD, including incentives for delivery among these groups.
On GP practice data, the report advised DHSC to consider the ‘costs and benefits’ of gaining ‘greater access to primary care data’ in order to improve monitoring of the NHS Health Check Programme.
The NAO said: ‘DHSC and NHSE should assess the effectiveness of data flows between DHSC, local authorities and primary care to inform a data improvement programme.
‘This should include an assessment of the feasibility of adding health check data to CVDPREVENT and of the costs and benefits of giving DHSC greater access to primary care data.’
The report highlighted that in 2023/24, only 3% of local authorities delivered a health check to all of the annual eligible population in their areas, with less than half of the eligible population attending.
While the NAO recognised that GPs play ‘an important role’ in ‘opportunistically’ identifying people at risk of CVD – for example if they present with other health concerns – it stressed that this approach ‘does not address undiagnosed people who may not otherwise interact with health services’.
The report also said that NHS England’s QOF incentives for GPs to meet CVD-related targets do ‘not focus on under-served populations’.
Head of the NAO Gareth Davies said that ‘thousands of lives’ are lost to CVD every year, and ‘billions of pounds spent tackling it’.
He continued: ‘Health Checks can play a crucial role in bringing these numbers down, but the system isn’t working effectively, resulting in not enough people having checks. This is an unsatisfactory basis for delivering an important public health intervention.
‘The Department of Health and Social Care needs to address the weaknesses in the current system for targeting and delivering Health Checks if it is to achieve the preventative effect it wants.’
Chair of the Committee of Public Accounts Geoffrey Clifton-Brown said it is a ‘missed opportunity that less than half of those eligible’ are attending NHS Health Checks.
He added: ‘The Department of Health and Social Care needs to take action to systematically boost uptake, target checks at those most in need, and drastically improve its data if the programme is to deliver the financial and health benefits intended.’
DHSC said it will ‘carefully consider the findings of this report’ and that the Government ‘is committed to taking action on preventable, deadly diseases like cardiovascular disease’.
A spokesperson continued: ‘Since this research was conducted, we have begun to pilot comprehensive heart health checks in workplaces , and we are developing a digital version of the check to provide an even more accessible and convenient service for people.’
DHSC also highlighted that the first quarter of 2024/25 showed the highest number of invites offered in a first quarter since the current programme started in 2013.
Currently, face-to-face checks – predominantly delivered by GP practices – are aimed at adults in England aged 40 to 74 every five years.
A new digital version of the check will be piloted in selected areas from early next year, with patients able to complete it via the NHS App from home. This will then be scaled up nationally from late 2025/26.
Recommendations for Government from the NAO
- DHSC should review the relative value of commissioning health checks through local authorities against alternative commissioning routes, such as NHS England, which could include incentives for delivering health checks in the Quality and Outcomes Framework for primary care practitioners.
- DHSC should set clear targets or expectations for the numbers or percentages of the eligible population who should attend health checks.
- DHSC should incentivise delivery of health checks towards the groups in the population that are at highest risk of CVD to help mitigate health inequalities and reduce potential longer-term costs falling on the NHS in the future.
- DHSC and NHS England should assess the effectiveness of data flows between DHSC, local authorities and primary care to inform a data improvement programme. This should include an assessment of the feasibility of adding health check data to the tool, CVDPREVENT and of the costs and benefits of giving DHSC greater access to primary care data.
Source: NAO ‘Progress in preventing cardiovascular disease’ report
A version of this story was first published by our sister title Pulse
